NPI | 1992793400 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9100929) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 132201) |
Enumeration Date | 2005-10-10 |
Last Update Date | 2025-06-02 |